ASPIRIN DESENSITIZATION-TREATMENT OF ASPIRIN-SENSITIVE PATIENTS WITH RHINOSINUSITIS-ASTHMA - LONG-TERM OUTCOMES

Background: Aspirin-sensitive patients with asthma experience continuo us inflammation of their nasal and sinus tissues, complicated by recur rent sinusitis, which frequently leads to asthma attacks. Systemic cor ticosteroid therapy and sinus or polyp surgery are currently required to central underlying rhinosinusitis, and bursts of corticosteroids ar e used for asthma control. Objective: After aspirin desensitization th erapy, objective measures of respiratory disease activity, linked to t he need for systemic corticosteroids and sinus surgery, were studied t o determine whether any changes occurred. Methods: Sixty-five aspirin- sensitive patients with asthma underwent aspirin challenge, followed b y aspirin desensitization and daily treatment with aspirin over 1 to 6 years (mean, 3.1 years). Clinical outcome measurements before aspirin desensitization treatment and during follow-up were analyzed for the larger group of 65 patients and subgroups (29 patients receiving thera py for 1 to 3 years and 36 patients receiving therapy for 3 to 6 years ). Results: In the larger group of 65 patients, there were significant reductions in numbers of sinus infections per year (median, 6 to 2), hospitalizations for treatment of asthma per year (median, 0.2 to 0), improvement in olfaction (median, 0 to 2), and reduction in use of sys temic corticosteroids (mean, 10.2 to 2.5 mg) with p values less than 0 .0001. Numbers of sinus and polyp operations per year were significant ly reduced (median, 0.2 to 0; p = 0.004), and doses of nasal corticost eroids (in micrograms) were significantly reduced (mean dose, 139 to 1 06 mu g, p = 0.01). Emergency department visits and use of inhaled cor ticosteroids were unchanged. Conclusions: The results support a role f or aspirin desensitization treatment of aspirin-sensitive patients wit h rhinosinusitis-asthma.